Uptake of oral antivirals for COVID-19

He Ako Hiringa
26 February 2024

To date, two oral antiviral agents have been approved in Aotearoa New Zealand for treating COVID-19 in adults who are at increased risk of progressing to severe disease, hospitalisation or death.1,2 This article reports on the uptake of these medicines between April 2022 and December 2023, based on dispensing data provided by Te Whatu Ora.3

This resource will not be available after 30 June 2024 as He Ako Hiringa is shutting down. If your organisation would like to host this resource please contact admin@akohiringa.co.nz

Availability timeline

  • April 2022: Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged) listed on the pharmaceutical schedule4
  • May 2022: Molnupiravir (Lagevrio) approved for use only where nirmatrelvir/ritonavir clinically inappropriate or unavailable2,5
  • February 2023: Ministry of Health Therapeutics Technical Advisory Group advise molnupiravir no longer recommended in Aotearoa due to lack of clinical efficacy in highly vaccinated populations and with transmission of Omicron variants6
  • 31 January 2024: All stocks of molnupiravir capsules expire, with no plan to obtain further supplies7

Dispensing data

The COVID-19 oral antivirals dispensing data3 were explored by total number of courses as well as patient ethnicity, socioeconomic deprivation quintile, age and gender. Findings are detailed below.

1. More Paxlovid dispensed than molnupiravir

More than 198,000 courses of Paxlovid and molnupiravir were dispensed over the period. Overall, the vast majority (76 per cent) of dispensings were for Paxlovid, with 24 per cent of patients receiving molnupiravir.

Molnupiravir reduced from 35.6 per cent of total dispensings in the first year to 10.6 per cent in 2023.

Number of courses dispensed, by year
2022 (April–Dec) 2023 (Jan–Dec) Total
Molnupiravir 36,817 (35.6%) 10,132 (10.6%) 46,849 (23.6%)
Paxlovid 66,684 (64.4%) 84,671 (89.4%) 151,355 (76.4%)
Total 103,501 (100%) 94,703 (100%) 198,204 (100%)


2. Variations between ethnicities in dispensing of COVID-19 antivirals

The vast majority of Paxlovid or molnupiravir courses (152,319; 77.7 per cent) were dispensed to people of European/Other ethnicities, followed by Asian (13,838; 7.0 per cent), Māori (21,952; 11.2 per cent), and Pacific peoples (8031; 4.1 per cent).

When compared to population estimates8, proportionately more European/Other people were dispensed COVID-19 oral antivirals than people of all other ethnicities, suggesting inequitable access to these medicines.

Number of courses dispensed, by ethnicity
Asian European/Other Māori Pacific Total
Molnupiravir 3161 35,757 5349 1837 46,104
Paxlovid 10,677 116,562 16,603 6194 150,036
Total 13,838





3. People in less socioeconomically deprived areas dispensed more Paxlovid or molnupiravir

A higher proportion of people living in the least socioeconomically deprived areas (22.1 per cent; Dep 1) were dispensed Paxlovid or molnupiravir compared with those living in areas of highest socioeconomic deprivation (16.1 per cent; Dep 5).

The proportion of people dispensed COVID-19 oral antivirals decreased with increasing deprivation, suggesting inequitable access to these medicines.

Number of courses dispensed, by socioeconomic deprivation quintile*
Dep 1 Dep 2 Dep 3 Dep 4 Dep 5 Total
Molnupiravir 8333 9220 9589 9516 8591 45,249
Paxlovid 34,379 32,625 30,300 28,212 22,587 148,103


193,352 (100%)

* Socioeconomic deprivation is represented on a scale of 1 to 5, where Dep 1 represents people living in areas of least deprivation, and Dep 5 represents people living in areas of highest deprivation.


4. Highest proportion of dispensings for Paxlovid or molnupiravir among those aged 65–79

Most people who received a dispensing of Paxlovid or molnupiravir were aged 65–79 (100,927; 51.3 per cent), with those aged 80 and over being the next highest user group (48,866; 24.8 per cent) by age band.

This is likely due to these populations being at highest risk of COVID-19 complications, and one of the access criteria age restrictions being set at 65.

Number of courses dispensed, by age band
<18 18–39 40–64 65–79 ≥80 Total
Molnupiravir 9 1072 8323 21,034 15,852 46,290
Paxlovid 102 5028 32,513 79,893 33,014 150,550
Total 111




5. More women than men dispensed Paxlovid or molnupiravir

Of the almost 200,000 people dispensed either Paxlovid or molnupiravir for treatment of COVID-19 during April 2022 to December 2023, 57 per cent were female and 43 per cent were male.

Number of courses dispensed, by gender
Female Male Total
Molnupiravir 25,191 (54.5%) 21,037 (45.5%) 46,228
Paxlovid 87,297 (58%) 63,156 (42%) 150,453
Total 112,488 (57%) 84,193 (43%) 196,695


Equity considerations

We cannot tell how many people with COVID-19 were eligible for treatment with oral antivirals but did not receive them, or the reasons for this, as these data are not available.

However, the dispensing data do show variations that are suggestive of inequitable access to Paxlovid and molnupiravir for the treatment of COVID-19:

  • Compared to population estimates, proportionately more European/Other people were dispensed COVID-19 oral antivirals than people of all other ethnicities (despite a pro-equity access criteria for Māori and Pacific peoples having been in place since the medicines became available).

  • People living in areas of least deprivation were more likely to be dispensed the medicines than those living in areas of higher deprivation, and the proportion of people dispensed COVID-19 oral antivirals decreased with increasing deprivation quintile.

Caveats to data interpretation

  • Since Paxlovid and molnupiravir became available there have been multiple changes to their access criteria (including age restrictions by ethnicity). Current access criteria can be found on the Pharmac website.
  • Totals differ between tables due to exclusion of null data (“other” and “unknown”) from each category.
  • Medicines dispensed does not necessarily equal medicines taken.
  • Patients will have been counted more than once if they received more than one course of antivirals.


  1. New Zealand Ministry Health. Medsafe data sheet (Paxlovid). 11 December 2023 medsafe.govt.nz/profs/datasheet/p/paxlovidtab.pdf
  2. New Zealand Ministry Health. Medsafe data sheet (Lageviro). 11 October 2023 medsafe.govt.nz/profs/datasheet/l/lagevirocap.pdf
  3. Data provided by Te Whatu Ora Health New Zealand. December 2023. https://www.tewhatuora.govt.nz/our-health-system/data-and-statistics/nz-health-statistics/national-collections-and-surveys/collections/pharmaceutical-collection
  4. Pharmac Te Pātaka Whaioranga. Decision on access criteria for oral COVID-19 treatments. 31 March 2022. https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/2022-03-31-decision-on-access-criteria-for-two-oral-covid-19-treatments?page=23
  5. Pharmac Te Pātaka Whaioranga. Updated Access Criteria for antiviral COVID-19 treatments. 28 April 2022. pharmac.govt.nz/news-and-resources/consultations-and-decisions/2022-04-28-decision-oral-covid-treatment-widened-access Accessed February 2024.
  6. Therapeutics Technical Advisory Group Te Rōpū Haumanu Kowheori-19. Update for health professionals: molnuparivir is no longer recommended by Therapeutics TAG due to lack of clinical benefit. 27 February 2023. tewhatuora.govt.nz/assets/For-the-health-sector/COVID-19-Information-for-health-professionals/COVID-19-/Therapeutic-Technical-Advisory-Group-Position-Statement-to-remove-recommendation-to-use-molnupiravir.pdf Accessed February 2024.
  7. Pharmac Te Pātaka Whaioranga. New Zealand’s COVID-19 treatments portfolio. First published 6 August 2021. pharmac.govt.nz/news-and-resources/covid19/treatcovid Accessed February 2024.
  8. Stats NZ Tatauranga Aotearoa. Ethnic group summaries reveal New Zealand’s multicultural make-up. 3 September 2020. stats.govt.nz/news/ethnic-group-summaries-reveal-new-zealands-multicultural-make-up Accessed February 2024.


Data manipulation by: Dr Alesha Smith, director Matui Ltd, developers of the He Ako Hiringa EPiC dashboard

Written by: Andrea Copeland, education lead He Ako Hiringa

Edited by: Dr Noni Richards, senior consultant Matui Ltd